A boy watches as malaria medicine is given out to patients at a malaria clinic in Sittwe, Myanmar. Shoddy and phony malaria drugs are a longstanding problem in the country.

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Originally published on December 20, 2012 4:44 am

Counterfeit drugs are a growing scourge around the world. They're generating millions of dollars in revenue for organized crime and fueling the rise of drug-resistant parasites.

Anti-malarials are among the most popular drugs to fake. But these faux pharmaceuticals are particularly dangerous because malaria can kill a person in a matter of days.

"Someone comes with malaria," says Stephane Proux, a researcher at the Shoklo Malaria Research Unit in Thailand, setting up a scenario. A seller will say, " 'Here you go, and take those tablets.' But there's nothing in there. ... It's very dangerous, potentially fatal for the patient."

SMRU helps to set up and run malaria clinics across the Thai border in Myanmar, also known as Burma. Myanmar has the highest level of malaria transmission in Southeast Asia, and it has been flooded with phony malaria drugs.

A lengthy civil war in Myanmar fueled both malaria and the counterfeit drug problem. Soldiers and villagers were pushed into mosquito breeding grounds. The conflict devastated health clinics, and it allowed smugglers to move with relative ease in and out of the country.

In Myanmar, malaria drugs and many other medications are sold openly without a prescription in markets and small shops. Proux says counterfeiters are playing with people's lives by selling useless medicines.

"That's a deadly trade. Those people are not only crooks, they are criminals, definitely criminals," he says.

Sometimes the fake drugs are nothing more than repackaged sugar pills or chalk. But at times, they contain small amounts of anti-malarial drugs.

That causes another major public health problem. When the malaria parasite is exposed to an insufficient dose of a drug, resistance can start to develop. And that appears to be happening now in Southeast Asia with one of the most powerful anti-malarials, artemisinin.

Drugmakers put holograms on drug packaging to authenticate the contents. "In the early days, it was quite easy to tell the fake from true because the hologram[s] were really badly done and very rough, and you could see straight away that it was fake," Proux says.

He says that started to change around 2004 or 2005. The malaria drugs for sale in eastern Myanmar became almost indistinguishable from the authentic ones. The packets even had hologram stickers that were nearly identical to the stickers from the factory.

"They are champion counterfeiters those guys. They are really, really well crafted holograms," Proux says.

Oxford University epidemiologist Paul Newton, who is based in Laos, has studied the trade in fake malaria drugs for more than a decade. He says shoddy and counterfeit medications have been a major problem for at least 10 years, and they're responsible for reducing the efficacy of malaria drugs throughout Southeast Asia.

But the problem isn't limited to that region of the world.

Economist Roger Bate, from the American Enterprise Institute, just wrote the book Phake: The Deadly World of Falsified and Substandard Medicines about the rise of phony pharmaceuticals around the globe. He says fake malaria drugs are a favorite among counterfeiters.

"It's impossible to know the exact scale of the problem of fake anti-malarials," he says. "But in some markets, it's as low as single-digit percentages, and in the worst markets half the market is fake."

For instance, he says, in Lubumbashi, the most southern city in Congo, 48 percent of malaria drugs sampled didn't work.

Even if they're worthless against malaria, these phony drugs can generate millions of dollars for organized criminals.

Bate says part of the problem is that malaria mainly affects people in developing nations where pharmaceutical regulation is weak. Drug regulatory agencies in malaria-endemic countries, he says, simply aren't strong enough to take on the counterfeiters.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

This week at NPR, we're also spending some time learning about malaria. The disease is pushing back against efforts to defeat it. Among the reasons that's happening: counterfeit malaria medicines. The fake drugs are generating millions of dollars for organized crime, undermining the effectiveness of existing drugs and killing patients. And efforts to attack the counterfeit malaria drug trade are weak, as NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: Myanmar has the highest level of malaria transmission in South East Asia. It's also awash in fake malaria drugs, according to researchers who study the problem. The lengthy civil war in Myanmar, also known as Burma, fueled both malaria and the counterfeit drug problem. The conflict pushed soldiers and villagers into mosquito breeding grounds. It also decimated health clinics and allowed smugglers to move with relative ease in and out of the country.

For more than 10 years, Stephane Proux has been gathering samples of malaria pills from pharmacies and shops along the Thai/Myanmar border.

(SOUNDBITE OF BANGING)

STEPHANE PROUX: And you see some of them I threw away because they're too old.

BEAUBIEN: Proux digs through a box filled with packets of malaria tablets that were bought mainly in Eastern Myanmar.

PROUX: In the early days, it was quite easy to tell the fake from true because the hologram were really badly done and very rough and you could see straight away that it was fake.

BEAUBIEN: But he says around 2004 or 2005 that started to change. The fake malaria drugs for sale in the region became almost indistinguishable with the naked eye from the authentic ones. The packets even had hologram stickers that were almost identical to the stickers from the factory.

BEAUBIEN: Proux works at the Shoklo Malaria Research Unit in Mae Sot, Thailand. His group helps set up and run malaria clinics across the border in Myanmar in areas where there's little access to health care.

Malaria drugs and many other medications are sold openly there without a prescription in markets and small shops. Fake drugs are particularly dangerous with malaria because the disease can kill a person in a matter of days.

Proux says by putting useless medicines out in the market, counterfeiters are playing with people's lives.

PROUX: Someone comes with malaria, here you go and take those tablets. But there's nothing in there. And so it's very dangerous, potentially fatal for the patient. No, that's a deadly trade. Those people are not only crooks, they are criminals, they're definitely criminals.

BEAUBIEN: Sometimes the fake drugs are nothing more than repackaged sugar pills or chalk, but at times they contain small amounts of anti-malarial drugs.

This causes another major public health problem. When the malaria parasite is exposed to an insufficient dose of a drug, resistance can start to develop. And that appears to be what's happening now in South East Asia with one of the most powerful anti-malarials in the market.

Oxford University scientist Paul Newton, based in Laos, has studied the trade in fake malaria drugs for more than a decade.

PAUL NEWTON: They've been a major problem over at least the last 10 years, a group responsible for reducing the efficacy of the treatments of malaria in countries throughout mainland South East Asia.

BEAUBIEN: And the problem isn't limited to South East Asia. Roger Bate just put out a book this year on the rise of fake pharmaceuticals around the globe. He says fake malaria drugs are a favorite among counterfeiters.

ROGER BATE: It's impossible to know the exact scale of the problem of fake anti-malarials. But it is in some markets as low as single digit percentages and in the worst markets half the market is fake. In a few instances we found in Lubumbashi, which is the southern-most city in the Congo - Democratic Republic of Congo - 48 percent of our sample simply didn't work.

BEAUBIEN: Even if they're worthless against malaria, these phony drugs can generate millions of dollars for organized criminals.

Bate says part of the problem is that malaria mainly affects people in poor developing nations where regulation of pharmaceuticals is weak. Drug regulatory agencies in malaria endemic countries, he says, simply aren't strong enough to take on the counterfeiters.

Jason Beaubien, NPR News.

(SOUNDBITE OF MUSIC)

GREENE: And our series Malaria Pushing Back, continues this afternoon on ALL THINGS CONSIDERED. Jason will look at the history of U.S. efforts to battle the disease.